Frequency of Treatment Failure of UTIs in Children With Congenital Urinary Tract Anomalies

Authors

Catherine S Forster
Alexis C Wood
Stephanie Davis-Rodriguez
Pearl W Chang
Sanyukta Desai
Michael Tchou
John M Morrison
Jamie D Mudd
Brittany D Casey
Victor Trevisanut
Rana F Hamdy
Vijaya Vemulakonda
Patrick W Brady
Sowdhamini S Wallace
UTI in Children with CAKUT Study Group

Publication Date

3-1-2024

Journal

Hospital Pediatrics

DOI

10.1542/hpeds.2023-007427

PMID

38374793

PMCID

PMC10896743

PubMedCentral® Posted Date

2-20-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Child, Humans, Infant, Newborn, Infant, Child, Preschool, Adolescent, Retrospective Studies, Urinary Tract Infections, Treatment Failure, Anti-Bacterial Agents, Bacteremia, Urinary Tract, Urogenital Abnormalities, Vesico-Ureteral Reflux

Abstract

OBJECTIVES: Children with certain congenital anomalies of the kidney and urinary tract and neurogenic bladder (CAKUT/NGB) are at higher risk of treatment failure for urinary tract infections (UTIs) than children with normal genitourinary anatomy, but the literature describing treatment and outcomes is limited. The objectives of this study were to describe the rate of treatment failure in children with CAKUT/NGB and compare duration of antibiotics between those with and without treatment failure.

METHODS: Multicenter retrospective cohort of children 0 to 17 years old with CAKUT/NGB who presented to the emergency department with fever or hypothermia and were diagnosed with UTI between 2017 and 2018. The outcome of interest was treatment failure, defined as subsequent emergency department visit or hospitalization for UTI because of the same pathogen within 30 days of the index encounter. Descriptive statistics and univariates analyses were used to compare covariates between groups.

RESULTS: Of the 2014 patient encounters identified, 482 were included. Twenty-nine (6.0%) of the 482 included encounters had treatment failure. There was no difference in the mean duration of intravenous antibiotics (3.4 ± 2.5 days, 3.5 ± 2.8 days, P = .87) or total antibiotics between children with and without treatment failure (10.2 ± 3.8 days, 10.8 ± 4.0 days, P = .39) Of note, there was a higher rate of bacteremia in children with treatment failure (P = .04).

CONCLUSIONS: In children with CAKUT/NGB and UTI, 6.0% of encounters had treatment failure. Duration of antibiotics was not associated with treatment failure. Larger studies are needed to assess whether bacteremia modifies the risk of treatment failure.